THINK, a locally-based clinical research organisation, is making a global impact on improving the treatment and management of tuberculosis (TB)
story debbie reynolds pictures supplied
In KwaZulu-Natal in 2005 there was an outbreak of Extensively Drug Resistant TB (XDR TB) that created an increased awareness of the disease globally as people started to lose the battle against TB.
Soon after, Dr Ronelle Moodliar experienced how much of a burden it was becoming on the health system and population, with KZN having the highest number of drug resistant cases per population in the world.
“When I started working with TB patients at King Dinuzulu Hospital in Sydenham we were treating all the infected patients within our province out of one small room,” she says. “Now the entire hospital and several other decentralised hospitals in KZN are dedicated to treating drug resistant TB.
“Seeing the impact that drug resistant TB was having on patients; the terrible side effects of the medication, like deafness, made me passionate about doing something more to help.
“Because so many patients live in situations where up to 10 people share a room, we were often treating more than one person in a family for a disease that is very hard to manage. I became very frustrated by the state system and the lack of resources.”
Her outlook changed when she began working with clinical research. “Knowing I could have a long-term relationship with my patients, get to know their families and their particular social issues was like heaven for me.”
When THINK founder Dr Kristina Wallengren asked her to work for them, Dr Moodliar knew she had finally come home.
THINK employs around 200 dedicated women and men who carry out clinical research supported through international research funding, government consortia and the pharmaceutical industry.
Swedish scientist and Public Health expert Dr Wallengren started THINK in 2013 with a “sense of urgency” to do something to improve the lives of those with TB and HIV.
“With a PhD in Molecular Biology and Master of Public Health from Harvard, where I also did a post doc in Epidemiology, and having worked with TB and HIV in South Africa since 2005, research is the way I know how to make a difference,” says Dr Wallengren.
THINK is currently conducting clinical trials across three sites in KZN, one of which is the Botha’s Hill research clinic, aimed at improving diagnosis and treatment for TB and HIV infected individuals.
Attached to the Don McKenzie Hospital, the clinic opened in October last year and is headed by Dr Moodliar. She explains that their work is primarily testing shorter treatment regimens, including new drugs, under very well-controlled environments following strict international and national guidelines and ethical regulations.
Born out of inadequate treatment, drug resistant TB is a serious threat, considering TB is a highly infectious airborne disease that can affect anyone at any time. “The TB bug is so super intelligent that it can mutate so that certain drugs no longer work. There are now so many mutations making it increasingly difficult to treat that we are having to add far more drugs to the regimen,” says Dr Moodliar.
“Instead of a six-month course of four drugs used for drug sensitive TB, patients with drug resistant TB were having to take a 24-month course of up to seven drugs, one which was an injection that can cause deafness and that patients had to have every day for six months.”
Thanks to research conducted at THINK advising the WHO (World Health Organization) to change the treatment guidelines, the National Department of Health has replaced the injectable drug and is now offering a shorter nine-to-12-month regimen, which is groundbreaking for South Africa.
“It is the first country in the world to officially launch an all-oral short course regimen as part of its national TB programme. Through further clinical research conducted here, we are currently investigating even shorter (six months) and less toxic regimens with fewer drugs.”
Another of THINK’s objectives is partnering with district health offices to trace people who have been diagnosed with TB but been lost to follow up. “We are committed to finding those patients and making sure they receive appropriate treatment. We also give them an opportunity to be part of our clinical trials, which are all totally voluntary,” explains Dr Moodliar, adding that clinical research also involves engaging not just patients but communities.
“We formulate community advisory boards that meet on a monthly basis, and every trial we do goes through them. It is important that everyone is aware of what we are doing. As a result, when patients return to their communities, there is support in the community should they default or need help.”
With the ultimate aim to eradicate drug resistant TB, Dr Moodliar says she has to believe they are winning the war.
“We have not had new TB drugs in over 50 years and with the outbreak of XDR TB we have to work desperately hard to discover those new drugs which will be less toxic and work over a shorter period.
“We are doing groundbreaking clinical research right here in our own community with THINK, and I have seen outcomes that I know are already making a difference.” *